术后粘连性不全性肠梗阻的非手术治疗VIP免费

论著�文章编号�1007-9424(2011)03-0286-04术后粘连性不全性肠梗阻的非手术治疗王甘露*,侍立志*,贺德*,黎惠娟*,刘美群*,陈晖*,黄波*�摘要�!目的!探讨由石蜡油、二甲硅油及番泻叶制剂组成的混合性制剂在术后粘连性不全性肠梗阻非手术治疗中的价值。方法!将我院2005年3月至2008年5月期间收治的128例术后粘连性不全性肠梗阻成人患者随机分为对照组和治疗组2组。对照组(n=52)行常规的禁食,胃肠减压,补液治疗,肥皂水保留灌肠;治疗组(n=76)在对照组治疗的基础上,胃管内注入由石蜡油、二甲硅油及番泻叶制剂组成的混合性制剂。分析比较2组之间结果的差异,包括:非手术治疗成功率,梗阻症状完全缓解后恢复正常排气、排便的时间,恢复正常饮食的时间,以及复发率。结果!非手术治疗成功率对照组为69.2%(36/52),治疗组为92.1%(70/76),治疗组明显高于对照组(P<0.01)。恢复正常排气、排便平均时间对照组为47.8d,治疗组为32.5d;恢复正常饮食平均时间对照组为5.3d,治疗组为3.2d。治疗组恢复正常排气、排便及恢复正常饮食的平均时间均明显短于治疗组(P<0.01)。2组复发率差异无统计学意义(P>0.05)。结论!应用由石蜡油、二甲硅油及番泻叶制剂组成的混合性制剂可促进肠功能恢复,降低其外科手术的干预率。�关键词�!小肠梗阻;粘连;二甲硅油;非手术治疗;腹部手术�中图分类号�R574.5;R574.2;R656.7!!!�文献标志码�AClinicalResearchonNonoperativeTreatmentforIncompleteAdhesiveSmallBowelObstructionafterLaparotomy!WANGGan�lu*,SHILi�zhi*,HEDe*,LIHui�juan*,LIUMei�qun*,CHENHui*,HUANGBo*.*DepartmentofGeneralSurgery,ShenzhenBaoanPeople∀sHospital,Shenzhen518101,GuangdongProvince,ChinaCorrespondingAuthor:WANGGan�lu,E�mail:wangganlu12@163.com�Abstract�!Objective!Tostudytheapplicationvalueofmixedformulationsconsistingofparaffinoil,dimethylsiliconeoil,andsennapreparationsintreatmentforincompleteadhesiveintestinalobstructionafterlaparotomy.Methods!Onehundredandtwenty�eightpatientsdiagnosedincompleteadhesiveintestinalobstructionadmittedtothishospitalfromMarch2005toMay2008wererandomlydividedintotrialgroupandcontrolgroup.Forthecon�trolgroup,thetraditiontherapyincludingfasting,gastrointestinaldecompression,fluidreplacementtherapy,andenemawithsoapandwaterwereusedfortreatment.Forthetrialgroup,themixedformulationsconsistingofparaf�finoil,dimethylsiliconeoil,andsennapreparationswereinjectedintostomachbythenasogastrictubeonthebasisoftraditionaltreatmentusedforthecontrolgroup.Someindicatorsincludingthesuccessfulrateofnonoperativetreatment,thetimethatobstructivesymptomsresolvedandreturnedtonormalexhaustanddefecationandnormaldiet,andrecurrenceratewerecomparedbetweentwogroups.Results!Thesuccessfulrateofnonoperativetreat�mentininthetrialgroupweresignificantlyhigherthanthatinthecontrolgroup#92.1%(70/76)versus69.2%(36/52),P<0.01∃.Theaveragetimethatrecoveredtonormalexhaustanddefecationinthetrialgroupandthecontrolgroupwas32.5dand47.8d,respectively.Theaveragetimethatrecoveredtonormaldietinthetrialgroupandthecontrolgroupwas3.2dand5.3d,respectively.Thetimethatrecoveredtonormalexhaustanddefecation,anddietinthetrialgroupweresignificantlyshorterthanthoseinthecontrolgroup(P<0.01).Therecurrenceratehadnosignificantdifferencebetweentwogroups(P>0.05).Conclusion!Themixedformulationsconsistingofpar�affinoil,dimethylsiliconeoil,andsennapreparationsimproverecoveryofintestinalfunctionandreducesurgicalin�terventionrate.�Keywords�!Smallbowelobstruction;Adhesive;Simethicone;Nonoperativetreatment;Laparotomy�Foundationitem�ProgramsforScienceandTechnologyPlansofShenzhenBaoan(No.2007026)!�基金项目�深圳市宝安区科技计划项目(项...